For the reader's notice; that this post is shared from one of my assignments submitted for Master of Nursing Science course. Everybody is welcome to give comment, please.
1. Introduction
Reflective
journal writing is a teaching learning strategy within which the responsibility
for the student’s learning is shared by both educators and students. Reflective
journal writing enhances the use of self-analysis and critical thinking;
reinforce the important of utilizing theory to guide nursing practice
(Riley-Doucet & Wilson 1997). Reflective journal writing provides an
additional emphasis on the self to promote self-awareness and self evaluation
which is important for personal and professional development. Riley-Doucet
& Wilson, 1997 also recommended that implementation of innovative
educational approach to self-reflection is recommended for beginning nursing
student, and can be applied in any clinical setting to promote self-directed
learning.
Reflective journal writing provides the
private and confidential environment in which students and staff are free to
examine and reflect on their work with patients thoroughly and honestly without
fear of judgment and reprisal. Many experts identified that such kind of safe
learning environment is essential to learning the skill of self-reflection,
facilitating improvement in clinical practice.
As a
reflective learner in advanced nursing education, self-determination theory,
initially developed by Edward
L. Deci and Richard M. Ryan, is used as a framework for writing my professional journal. It is a
macro-theory of human motivation, personality development, and well being,
which suggests that people function effectively and experience greater mental
health when their behavior is autonomous rather than controlled (Ryan 2009). The
central assumption of self-determination theory is that the individual is born
with basic psychological needs required for autonomy, relatedness and
competence.
2. Life Experience in nursing profession
Nursing, provision of care to the people, is an
honorable career but it is challenging. I have been in nursing field for one
and half decade. My life as a nurse is not much rewarding because of my
personal life events, financial restraint and government policy. Struggling
with these restrictions and difficulties, I have never given up developing
myself. As it has been assumed by self-determination theory, people are active
organism with inherent and deeply evolved tendencies toward psychological
growth and development, and this active nature is clearly evident in the
phenomena of intrinsic motivation (Ryan 2009). I believe, likewise, that I have
innate nature of developing self, and helping development of others. This
innate nature has been driving me to endure pains and obstacles in life.
According to self-determination theory,
condition supporting the individual experience of autonomy, competence, and
relatedness are urges to foster the most volitional and high quality forms of
motivation and engagement for activities including enhanced performance,
persistence, and creativity. Rarely the nurses in Myanmar including myself
obtain as such supportive condition which facilitates internal motivation to
personal and professional development. Consequently, satisfactory quality of
nursing services is not deliberately contributed, and the patients and
community members are not receiving excellent health care as well as optimal
health and well being.
2.1. Preparation stage: being a student nurse and challenges
I
started four years Bachelor of Nursing Science course in 1996 and graduated in
year 2000. I had been exciting to learn biomedical and nursing subjects at the
beginning. We had been taught many nursing theories and models which were very
new to us. After learning these theories only, I understood what is nursing,
and the professional attributes. Supportively, we had to learn behavioral
sciences including psychology, sociology and communication skills.
The learning
environment within university campus was a healthy climate for us facilitating
conducive learning experiences, and acquiring positive attitudes toward the clients,
the community and the professional image. In clinical setting, however, it was
an extremely frustrating and depressing experience. Since degree program in
nursing had established in Myanmar just a few years before I joined, we were
facing negative and unsupportive reactions from medical doctors. Medical doctors are, even until now, holding
stereotyped value on nurses just as efficient assistants for them, and they
want to maintain that traditional role of nurses as the obedient followers or
helpers for the doctors. They discouraged and devalued nursing students who
were doing degree program. Some doctors openly expressed that nurses were not
necessary to have a degree to provide nursing care. When they noticed bachelor
of nursing students were conducting research, they commented that was not the
nurses’ job.
Unfavorably,
strong negative comments of the doctors influenced some of the senior nurses
and ward sisters that their traditional diseased-oriented and task-oriented
training was perfect. Yet those seniors and ward sisters were skillful in
clinical procedures, and their performances were highly credited by the
doctors, but their practices were not client-centered nursing care. Since the
dominating nursing practice was task-oriented, there had no reflective practice
and critical thinking on improvement of nursing care standard. Honestly, we
could not overcome their resistances to change the old tradition to the new
outlook. Hardly nursing professors and lectures from the university were unable
to influence the practicing nurses in clinical setting.
Therefore,
we did not get complete social and cultural conditions which promote our
volitional and self-determined behavior. This made us lack of confidence to
change the trend of nursing practice. Thank to the nursing and complementary
subjects I had learned and positive reinforcement of my devoted lecturers,
positive attitudes toward nursing professional and my innate nature of
developing self was still maintained.
2.2. Working experience and challenges in home country
I worked as a staff nurse in private medical
center after graduated, which was an exciting experience as a novice nurse.
Since it was in my 23, I was completely fresh and active physically and
mentally. I was eager to learn everything, and my seniors were supportively
guided me in dealing with patients’ care and performing therapeutic procedures.
I was happy with the favorable condition giving some form of autonomy, and safe
working environments, where supervision and proper guidance were always carried
out by ward sisters and the matron. It was because there were increasing
numbers of nurses graduated with updated nursing curricula, and the sisters and
matron also were aware the current trend at the time.
Although I enjoyed being a clinical staff, I
preferred to be a nurse educator. For this reason, I accepted the offer from
government, Department of Medical Science, Ministry of Health, as a nursing
instructor at the new Nursing Training School (NTS). In Myanmar, the job
descriptions for nursing instructors include delivering lecture and clinical
teaching. I taught Fundamentals of Nursing, and Medical and Surgical Nursing.
There were so many tasks to do other than classroom teaching and supervision of
the students in clinical setting. Since it was a new NTS, there were only 20
students in the first intake, and three educators; the principal, a tutor and
myself as an instructor.
Truly it was happened that the government
started to open new NTS without having the building, skill lab, essential equipment
and facilities. Therefore, government general hospital had to share one the
small ward as the building of NTS. The principal borrowed a bed from the
hospital to demonstrate basic nursing procedures. As a nature of bureaucratic
government system, they slowly provided the required equipment and supplies.
Since there was no office staff at the beginning, I did the entire clerical
task under guidance of the principal. I was satisfied with my teaching job, and
I love my students. However, on the other hand, it was very disappointing for
not having enough facilities. I had learnt that these conditions hindered my
students’ ability to prepare themselves as highly competent and confident nurses.
We had tried our best within our ability, no matter how the condition was
unfavorable, in order to produce the graduated nurses with some level of
confidence and competency. The resulted outcome was fairly satisfactory that we
received positive feedback on our first intake of graduated nurses.
According to self-determination theory, Ryan
(2009) claimed that although the natural growth tendencies underlying intrinsic
motivation are evolved, this does not imply that they operate robustly under
all conditions. He proposed that these inherent tendencies require specific
supports and nutriments from one’s social environment that are essential for
psychological growth, integrity, and wellness. I feel that statement is totally
true for me and my students. We have internal motivation, which needs
supportive environment and satisfaction to promote our capabilities and
potential leadership abilities. Unfortunately, we did not receive enough
support and resources, losing some potential and contributive efforts to the society.
If the organizational policy changes to provide equal opportunity and
facilities for nursing education, as it is providing to the medical education,
nursing students will be well-prepared to become highly qualified nurses. The
same idea should be applied in working environment, otherwise, job satisfaction
is not met and deficient in providing quality nursing care. Ryan (2009) also
supported that thwarting or frustration of the basic psychological needs;
autonomy, relatedness and competence, leads to diminished self-motivation and
greater ill-being.
Since I did not have enriched experience to
overcome these unsupportive and suppressive conditions, I have suffered from
lack of confidence to move forward and deficient in creativity for more
effective teaching learning strategy. Moreover, the government even could not
provide enough salary for us to cover daily expenses. This leads to increase
staff turnover and migrating to foreign countries. I finally decided to resign
from government service and migrated to work in Malaysia.
2.3. Working experience and
challenges in Malaysia
I worked as a staff nurse at Mawar
Haemodialysis Center, Seremban for two years. It had been some exciting
experiences as well as challenging situations. At the beginning, it was
exciting to learn heamodialysis (HD) procedures. At the same time, I had to
deal with some cultural conflicts and language barrier with the patients who do
not understand English. I had learned Bahasa Malaysia, to be able to
communicate with all patients and improve interpersonal relationship which is
important to get rapport in providing care and HD management. I was
well-adapted and settled in new situation within six months periods, and my
work performance was well-recognized. It could be considered that I had received
satisfactory working condition with minimal distractions.
Chief nursing officer was admirably powerful
and very straightforward that she could influence all staffs including
non-nursing personals. I learned from her that she was very disciplined, and
she herself strictly followed the disciplines she set up. She had full
confidence in administration the whole center with many branches, and I think
that confidence came from her devoted years of experiences in nursing, autonomy
and authority she had acquired. I felt that she has achieved successful career
life fulfilled with basic psychological needs mainly autonomy and
satisfaction. She has, therefore, been
highly contributive to the entire haemodialysis center with expert knowledge,
supportive supervision and effective leadership role model. She totally
influenced us to be obedient with rules and regulations as well as the
essential principles of nursing practice regarding management of patients
undergoing HD.
Working as a foreign staff, continuous professional
development had not been taken into account for us, and we did not get the
opportunity to attend any workshop or seminar conducted by other organizations
in Malaysia. Continuous learning opportunity, which I believed as a major
nutriment for my life-long career development, has been the main area of
interest for me. Although I received safe and healthy working condition, I was
not satisfied with lack of staff development concern for non-local staff. After
completing two years employment contract, I accepted the offer from UCSI
University.
Working at UCSI University under School of
Nursing has been another challenging experience for me. There, I was a clinical
instructor as well as the in-charge for nursing clinical skill unit. My job
descriptions were supervision of students in skill unit and clinical posting,
coordinating the timetable and schedules for lecture demonstration and
supervised practice, inventory control, and purchasing equipments and
consumables. Since my area of interest is teaching and educating, I was happy
with my students, supervising their practices, giving instructions and
corrective actions, providing positive attitudes toward nursing practice. On
the other hand, I was disappointed with doing inventory control, and dealing
with uncooperative staffs.
Thank to UCSI University providing equal
remunerations for local and expatriate staff, I had opportunity to attend
numbers of workshops, seminars and conferences conducted within and outside
university campus. Yet this kind support has been the required nutrition for my
personal growth and development so that I could build up some level of
confidence and new outlook to go further ahead. At the same time, I evaluated
myself that I needed further advanced education, and I wanted to have quality
education to upgrade my knowledge and experience. I had strong desire to study
in University of Malaya, which is the best place for me to get quality
education with affordable cost of study.
Since I was not allowed to study part-time by head of department, I
decided to stop working and enrolled in Master of Nursing Science course at
University of Malaya, Kuala Lumpur.
3. Planning for future professional journey
I am highly satisfied with studying master
degree in nursing, and I feel that satisfaction foster me to have a clear
vision for development of the entire nursing professional especially in
Myanmar. I have an intention to go back to my home country. If the situation is
feasible, I intended to study doctorate degree in nursing education because I
want to upgrade nursing education in Myanmar to achieve international standard.
Since professional development in nursing is
very slow in Myanmar that is mainly due to suppressive control by medical
profession and bureaucratic government policy, I plan to get involve in policy
making related to nursing education, setting rules and regulations in Myanmar
Nurses and Midwifes Council, and strengthening Myanmar Nurses Association. As I
have learned from my experiences, nurses need to get recognition, satisfaction
and empowerment so that they will grow as highly contributive individuals for
the community. Self- determination theory stated that psychological need
satisfaction is importantly influenced by the interpersonal and organizational contexts
that people encounter. Therefore, it is important to reform the regulatory body
and systems for nurses to promote satisfaction, and thus, develop full
confidence to take the leadership role in health care delivery.
I believe that
writing articles in local or international newsletters, journals or magazines
is one strategy for nurses to get involve in political issues; by this way
nurses will be well-recognized and highly visible among the public, and nurse
will posses some power, authority and autonomy to change the entire nursing
profession and discipline. With this belief, I have taken up writing career and
contributed some articles to one of Myanmar magazines. I am now preparing to
write academic article in English to become influential author. Thanks to the
compulsory assignments required to fulfil completion of my course, I have
acquired the practice to read a lot and write up which I love to do.
Self-determination
theorist asserted that intrinsic goals such as intimate relationships, personal
growth, or contributing to one’s community are conducive to need satisfaction,
and therefore facilitate health and wellness. A research study showed that extrinsic
goal framing undermined self-reported task enjoyment and personal valuation of
the activity and forestalled the individuals’ conceptual performance and
persistence (Vansteenkiste, Timmermans, Lens, Soenen, & Broeck, 2008). This
finding replicated the previous studies shown that the experimental induction
of intrinsic goals promotes better conceptual learning and persistence compared
to the induction of extrinsic goals (Vansteenkiste et al., 2008).
Vansteenkiste et
al. (2008) also reasoned that inducing the extrinsic goals such as wealth,
physical appeals and social recognition creates an outward orientation by
drawing individual attention toward external signs of worth. This attention
shift precludes the possibility of task-absorbed engagement in the activity, so
that the individuals fail to enjoy the learning activity and perform less well.
Extrinsic goal framing prompts some motivated learning which approached in
rigid and narrowed-minded fashion which promotes memorization of learning
material but interferes with an in-depth processing of the contents.
Rationally I agree with
the statement that intrinsic goals facilitate psychological well-being because
they provide direct satisfaction of the basic psychological needs. Highly I
appreciate and value on intrinsic motivation, engaging in an activity for its
own sake, simply because it is enjoyable. With this value, I will move forward
to empower the nurses through intrinsic motivation and intrinsic goal framing
leading to improve quality nursing care, thereby increasing healthy and productive human
resources.
4.
Conclusion
Development of reflective practice is central to
nursing education and clinical academic career in nursing. Freshwater, et al., (2008) supposed that the
notion of specialist knowledge should be defined by the individual and the
reflective development and application of theory and research within it, rather
than medical specialty. They added that individual nurse practitioners should
be open to examine and evaluate different theoretical and analytic perspectives
using critical reflection on their own practice-based knowledge and pattern of
knowing (cited from Carper, 1987; White, 1995). Writing professional journal
using theoretical framework in is an effective way to enhance critical
reflection.
5. Reference:
Freshwater, D., & Esterbuizen, P. (2008). Reflective
narrative: developing a career pathway. In D. Freshwater, B. J. Taylor, & G.
Sherwood (Eds.), International Textbook
of reflective Practice in Nursing (pp.223-234). United Kingdom, Oxford:
Blackwell publishing, Honor Society of Nursing.
Riley-Doucet,
C., & Wilson, S. (1997). A three step method of self-reflection using
reflective journal writing. Journal of
Advanced Nursing, 27(5). Retrieved from http://eproxy.um.edu.my
Ryan,
R. (2009). Self- determination theory and wellbeing. WeD Research Review 1. Welbeing in developing country (WeD), Center
for Development Studies, Unversity of Bath. Retrieved from http://www.welldev.org.uk
Self-Determination
Theory: An approach to human motivation & personality (2012). Retrieved on
8 March, 2012, from http://www.selfdeterminationtheory.org
Vansteenkiste, M., Timmermans, T., Lens, W.,
Soenen, B., & Broeck, A. V. ( 2008). Does Extrinsic Goal Framing
Enhance Extrinsic Goal-Oriented Individuals’ Learning and Performance? An
Experimental Test of the Match Perspective Versus Self-Determination Theory. Journal of Educational Psychology. 100(2),
387-397. Retrieve from http://www.selfdeterminationtheory.org
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